In 2007, my wife and I learned we were expecting. It was an amazing rush that was soon followed by total and complete panic. Like 13 percent of all pregnancies in the U.S., we found ourselves expecting and without health insurance. A pregnant woman lacking coverage is basically the same as someone diagnosed with stage 4 cancer; untouchable.
While this is a huge obstacle, there are avenues including simply negotiating with the hospital directly to help reduce costs.
At least we knew what we were in for, however even if you have health insurance, you may be in for more than you realize.
Only 14 states require maternity coverage to be included in their individual market plans, that is, plans you pay for out of your own pocket. But even in the presence of employer-subsidized plans, your company will need more than 15 employees to fall under the Pregnancy Discrimination Act of 1978 and thus provide additional maternity coverage.
So what is maternity insurance?
Well, during pregnancy, you will find yourself going to the doctor as much as two to three times a month, while there you incur visit fees. You will incur sonogram fees, prescription fees, wheelchair fees, and basically anything a hospital can put a fee on. Even with coverage, most of us have a co-pay amount that can range anywhere from $30 a visit to 70 percent of services rendered. There is also the possibility of a c-section or the dreaded 48-hour labor, all of which will ring up on the hospital cash register.
While individual health plans vary, these extra fees will add up rather quickly for virtually everyone. Unfortunately, many couples opt to skip appointments to save on costs. This is not a good plan and could endanger your child.
The promise of a maternity rider is to supplement your basic coverage and eliminate the chance of becoming one of the 62 percent of all bankruptcy claims per year that are brought about by insurmountable hospital bills. Almost 80 percent of those claims are from people with health insurance!
So, for an additional monthly fee, you can get some peace of mind and concentrate on having a healthy baby. Sounds good, and for couples actively trying to get pregnant, it seems pretty much like a no-brainer. However, buyer beware. Every plan varies in what it will cover and some even have fine print limiting your additional coverage to as little as $3000! You don’t have to be a math professor to see coverage like that will not add up when a relatively easy delivery averages over $7000 post basic coverage.
When researching maternity insurance online, be cautious. I found a simple Google search to yield a number of “dummy” sites designed to subtly steer you towards one company or another.
Do complete research and don’t be afraid to locate a reputable insurance broker in your area that can sit down with you face to face to explain the different plans. You never know when a company will consider the first pregnancy an “existing condition” and suddenly not cover your c-section.
And don’t wait! Much like regular individual plans, many maternity add-ons must be in place before you become pregnant.
This is a tricky puzzle. Maternity insurance seems like a great idea. The right plan is invaluable in covering all those extra costs, but do your homework, seek advice, and make sure you aren’t throwing money away at the wrong plan.